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Wednesday, August 29, 2007

I am not talking about people who are real doctors, ie people with a doctorate in some discipline or other, but about medical doctors (most of whom probably don't actually have a doctorate). - At a German university hospital a fraudster was found out not to be a medical doctor, only after she worked (successfully I might add) for four years at the hospital. The woman in question had no medical qualifications (she studied medicine but crashed thru various exams and never graduated). So she faked her graduation documents, applied for a post in the hospital and began to work. She also published a substantial number of scientific papers, quite a few of which received prizes for their excellence. In the end she was found out, suspended and is currently being prosecuted.

Nothing much in all of this is truly newsworthy, I guess. Over the years there's been a continuing trickle of fraudsters like this woman. Of course, we only ever learn about those fraudsters who have been found out, which makes one wonder how many non-medics work as medical doctors in our health care systems. It makes one also wonder what it is about medicine that drives folks to do such things. I mean, how often have you heard of someone pretending to be a philosopher who actually has no training in philosophy, or how often are lab technicians found out who actually have no training etc. I sometimes wonder whether it's to do with the quasi-religious side of medicine, its rituals and clothing (like: why should doctors have to wear a white coat? there is no particular scientific reason... it's really more like the colourful dresses priests tend to wear to distinguish themselves from the rest of us.- and how often do folks working in health care settings, who are not medics, aspire to (or actually do) wear a white coat, then there's white coat ceremonies etc etc). Medics usually respond with a vague nod toward 'tradition', and if that doesn't help with the grave responsibility for their patients' wellbeing (even life). This usually is also deployed to justify out-of-whack wage claims. The thing is, if responsibility for one's clients' lives was the relevant factor in determining one's legitimate claims in terms of salary, status etc, arguably the average bus driver carries in a day's work more responsibility than the average medic. So... what is it about the medical profession that makes it sufficiently desirable that people without such competencies lie and cheat to look like they're medical doctors?

Saturday, August 25, 2007

You might recall Dr Anna Pou, she was charged by prosecutors for murdering nine patients in her hospital in New Orleans when the dikes broke and the city began to flood. 34 people in all died in the hospital waiting for their evacuation. Dr Pou admitted to administering morphine and sedatives to the nine patients in question. She also admitted knowing that the dosages she used might hasten the patients death but insists that that isn't what she intended (here the Catholic doctrine of the double-effect swings into action - it's a kind of feel-good thing for medical professionals, saying essentially: I know I am likely to, or I am going to kill this patient, but I really don't mean to, my objective is to relief his/her suffering, and death really is an unintended side-effect of this...). Anyway, in the end the jury refused to indict her and the case came to a close. Here, on MSNBC is Dr Pou's version of events, and her explanation for her actions. If there's ever a fascinating read, it's this!

‘Everybody May Not Make It Out’

Dr. Anna Pou was accused of murdering nine patients in a New Orleans hospital wracked by Katrina, but a grand jury declined to indict her. Now she gives her side of the story.

Aug. 25, 2007 - The tragic deaths at New Orleans’s Memorial Medical Center after Hurricane Katrina are among the most notorious examples of the vast human suffering that resulted from the destruction of the levees and the flooding of the city—and the government’s incompetent response to the disaster. At least 34 people died in the hospital awaiting evacuation and it wasn’t long before dark rumors began circulating that some of them were helped along by lethal doses of morphine or other medication. Almost a year after the storm, in July 2006, authorities arrested Dr. Anna Pou, a well-known head and neck surgeon. She was eventually accused of murdering nine patients who were in a long-term acute care unit on the seventh floor run by LifeCare Hospital of New Orleans. (Two nurses were also arrested but their charges were later dropped.)

Late last month, a Louisiana grand jury refused to indict Pou and the highly controversial criminal case came to a close. Pou still faces several civil lawsuits brought by relatives of patients who died while at LifeCare. In her most extensive comments yet on the events surrounding those deaths, Pou tells NEWSWEEK’s Julie Scelfo that she did indeed administer morphine and a sedative to the nine patients and she knew that these medication might hasten their deaths. But, she says, killing them was not her intention. In the desperate calculation Pou and other medical professionals were forced to make in the chaos and madness that engulfed the hospital, she says some patients could be saved and others were almost certain to die. It was their suffering Pou says she sought to alleviate. Excerpts:

NEWSWEEK: What was it like after the levees broke?Dr. Anna Pou: Monday after the storm passed, we figured, ‘OK, minimal damage; we began organizing how we were going to evacuate the hospital.’ We didn’t have full power so we needed to move patients. Tuesday morning we were planning our day and one of the nurses called me to the window and said you’ve got to come see this. Water was gushing from the street. So we all kind of looked in disbelief. What is this? We could tell the city was flooding, you could see water down Claiborne Street. It was rising about a foot an hour. Then the whole mood at the hospital changed and what we were doing changed. We were in hurricane mode and we had to go into survival mode because we knew we had to be there for some time.

Who organized patient care?The chief of staff organized physicians. He got us all together and said we have a lot of patients in the hospital so we are going to assign physicians to different units and you can triage and decide how well patients can do with the evacuation.

How did you determine who was fit to be evacuated?On Tuesday, the categories were: ‘Is the patient well enough to be discharged home, or since they couldn’t go home, [released] into general population?’ The second group were those who needed to be discharged to a nursing-care facility. The third group were patients who were acutely ill who needed to go to an acute-care facility.

What was the hospital like? I know the hospital allowed those who worked there and their extended families to use it as a shelter.It made the situation much, much more difficult because we had people who shouldn’t have been there—physicians, nurses, employees, extended families, pets. That really comes into play because instead of a few hundred people to take care of there were 2,000 people. That [policy] was one of those errs in human judgment.

So who was evacuated Tuesday?The patients who were the sickest, babies in the nursery. We got the sickest people out that we could. There were very few helicopters. It was not like a fleet of helicopters came to take away a fleet of patients. They were very sporadic and …after dark, they don’t fly.

How did things change on Wednesday?Tuesday night, we lost generator power, and that changed things a lot. ‘Til then we were on generator power so we did have some lights, and we did have some water. Water wasn’t clean, but it was running. But then we didn’t have water, we didn’t have any electricity, commodes were backing up everywhere. Conditions in the hospital started to deteriorate Tuesday night and early Wednesday. When that happens it makes care a lot more difficult. I was called to help suction a patient who had a tracheotomy but we had no suction running. We were going down to very, very basic care. You try every old-time method you can … [P]eople in charge were trying to get helicopters to come, [but] at that time we were told we were low priority. There were people on rooftops [who were going to get rescued first]. They said … there’s not going to be a lot of help coming, [so] what we decided [was] if helicopters were going to show up sporadically, we have to have patients ready and waiting to go.

How many people had died at this point?I can’t tell you the number. The morgue was full and patients were already in the chapel, people were asking for body bags and “What do we do with bodies?"

In normal triage situations, the sickest people are treated first. But my understanding is that conditions were so bad, you and the other medical staff switched to a reverse triage or battlefield approach. Tell me about this.The conditions were unbearable. Inside the hospital it was pitch black, with odors, smell, human waste everywhere. It was very rancid. You would take a breath in and it would burn the back of your throat. The patients were very sick. That’s when we had to go from triage to reverse triage because we came to realize if patients aren’t being evacuated, [we had to deal with what we had]. Basically it was a general consensus that we’re not going to be able to save everybody. We hope that we can, but we realize everybody may not make it out.

What were the categories?We divided patients into groups one, two and three. Patients in category one are able to sit up and walk and are not very sick. Patients in three are critically ill, “Do Not Resuscitate.” The ones in category two were sick, but doing much [better than those in category three]. The triage system was very crude—we’d write the number 1, 2 or 3 on a sheet of paper and tape it across the patient’s chest with their hospital records. There was limited use of flashlights. There were limited batteries. [Parts of the hospital] were pitch black. I’m talking jet black. Very dangerous. It was pitch dark in inner rooms.

What is the reverse triage process like?Let me tell you, for a patient to be triaged—typical triage isn’t that difficult. Reverse triage is heart wrenching. Absolutely heart wrenching. You place patients into categories. With boats coming and going we could evacuate patients who could sit. There were elderly couples—how do you make that decision who can go when one was sick and the spouse wasn't? Do you let elderly couples go together as husband and wife? Some of these couples had been married 50 years.

When was the first time you were on the seventh floor LifeCare acute unit? How did you come to be there?On Monday, mid afternoon around 2 p.m. or 3 p.m, the intercom system was still working then. I was with nurses, doing things like setting up emergency operating rooms. We heard a code, a code in LifeCare. The nurse next to me said, “Anna, I think you better go. I don’t think there’s anybody up there.” So I ran up the stairs and when I got there, there was a patient who had arrested and some nurses in room. I intubated the patient, put an endotracheal tube in. The nurses had already started the code. Then another physician came up from the emergency room. The patient didn’t survive. What was interesting to me was that my friend said, “You better go there, I don’t think there’s any doctor there.” The nurses said it’s rare we get a doctor there on LifeCare.

Tell me about conditions from Wednesday night until Thursday.By the time Wednesday evening came around, if you can imagine in our mind, there is a central area that is a sea of people. A lot of very sick patients in that central triage area. It’s grossly backed up. Few patients had been evacuated. So there was just enough space to walk between the stretchers. It is extremely dark. We’re having to care for patients by flashlight. There were patients that were moaning, patients that are crying. We’re trying to cool them off. We had some dirty water we could use, some ice. We were sponging them down, giving them sips of bottled water, those who could drink. The heat was—there is no way to describe that heat. I was in it and I can’t believe how hot it was. There are people fanning patients with cardboard, nurses everywhere, a few doctors and wall-to-wall patients. Patients are so frightened and we’re saying prayers with them. We kind of looked around at each other and said, “You know there’s not a whole lot we can really do for those people.” We’re waiting [for help]. The people in that area could have [been evacuated] by boat but no boats were coming. I would do what I could with the nurses: changing diapers, cooling patients down with fanning. It wasn’t like, “I’m a doctor, you’re a nurse.” We were all human beings trying to help another human being, whatever it took.

Were people still dying at this point?Every now and then a nurse would say, “Dr. Pou, this patient isn’t breathing any more.” Or I would be fanning patients and watch them take their last breath. So that’s basically what it was like Wednesday night: kind of a feeling of helplessness, frustration, sadness. It’s sad. You look around and think we live in the greatest country in the world and yet the sick could basically be abandoned like this.

What happened Thursday?On Thursday morning we were told nobody was coming and we had to fend for ourselves. Everybody was kind of like at a loss here. What is plan B? Or plan C?

At what point did it become clear some patients wouldn’t make it out alive?I think when we went to reverse triage. It was always everybody’s hope that every single person would make it out of the hospital. Everybody did everything to make that happen. What you have to do when resources are limited, you have to save the people you know that you can save. And not everybody is going to survive those kind of conditions. And we knew that. People were dying. People were dying in the hospital. Not through lack of effort. Healthy people were getting sick. Employees’ family members were getting sick. People from the neighborhood came in getting sick. We were trying to find insulin for people. It was a mass of people—very chaotic. You have to realize there were people everywhere, not only patients, but 2,000 people in the hospital. That is a lot of people.

Tell me about the decision to administer painkillers to the nine people on the seventh floor.There were patients, all of us knew, still remaining in the LifeCare unit. They were category three [in the reverse triage system]. We all believed eventually everybody was going to leave the hospital. We just didn’t know when or what was the time frame. So we knew that patients were going to be there for long time. We knew they were going to be there another day. That they would go through at least another day of hell. Basically it was decided to give the patients sedation.

Who exactly made the decision?It was basically a group decision. I was asked to go check on patients on LifeCare.

So who was the doctor in charge on the LifeCare’s acute unit on the seventh floor?To my knowledge nobody was there. The medical director was not there.

Who sent you to the seventh floor?It was a group decision. I didn’t really volunteer for anything.

How did you come to be the one administering the injections? Louisiana Attorney General Charles Foti made a point of saying you had administered medication to people who were not your patients.This was an emergency situation. There were no LifeCare doctors. In an emergency situation, the patients become everybody’s patients. What are you supposed to do if a patient needs to be cleaned and have IV fluids, say, “You’re not my patient, good luck”? That’s absurd. If that’s the case I dare say three-fourths of the population of Memorial Hospital would have been left without a doctor. We’re in medicine because we care about people. This is what we do. We don’t run around murdering people. That’s why what he said is so ludicrous.

What was your intention when you administered injections to the nine patients in the acute unit?The intention was to help the patients that were having pain and sedate the patients who were anxious. That was it. Reverse triage meant the sickest would be the last to be triaged. We didn’t know how much longer they would be there. I take care of patients with cancer, so if I was a murderer, it would really be an interesting combination, very incongruous.

Did you consider when giving the injections that they might hasten these patients’ deaths?I guess the thought crossed my mind. Any time you give medicine it crosses your mind. There’s always a risk of hastening death. There is a risk with every single thing we do in medicine. Every time you give antibiotics there’s a risk.

Did that factor into your decision to administer these painkillers and sedatives?Basically what we’re trying to do is help the patients. Let me tell you—God strike me dead—what we were trying to do was help the patients. Everything was done with their best interest in mind. First and foremost. Any medicines given were for comfort. If in doing so it hastened their deaths, then that’s what happened. But, this was not, “I’m going to go to the seventh floor and murder some people.” We’re here to help patients.

How uncomfortable were the patients on the seventh floor?I don’t want to be disrespectful to the dead [and give any specifics]. In general, LifeCare patients are very sick people, extremely ill or chronically ill. [And the harsh environment] took a toll on patients. Patients were dying.

As a physician how do you balance risk and the need for palliative care?Any physician cannot practice medicine if we could not give painkillers. It would be barbaric. “Oh you’re dying of metastatic lung cancer, but if we give you morphine for pain, you may die a day earlier?” What do you do, not give the medicine? So it is usually disease and illness that is responsible for a patient’s death. The intention is to alleviate pain and give the patient the best quality of life. That is part of the Hippocratic oath, that I’m not going to let you die in misery and agony. It was a very, very helpless, helpless experience. All you could do is make them comfortable. And I shouldn’t downplay that.

When did you leave the hospital and who was still there when you left?I left Thursday around 6 p.m. in a helicopter. When I left no one was in the hospital. There were a handful of patients on the helipad. I went to [another hospital and then] on a bus to Baton Rouge because my family was there.

How did you feel?I was tired but I was more in total disbelief that the sick and the poor could be abandoned the way that they were in the United States of America. I never thought I would ever live to see that day. I was sad, heartbroken, kind of amazed and shocked at the lack of organization—the fact that there was no type of coordination. I have friends who practice in the third world and this was less than third world.

What was it like to be arrested in 2006?I had [performed] surgery that Monday. It was bedlam in the medical community after Katrina. I had surgery Monday, Tuesday, Wednesday, Thursday and clinic on Friday. And the attorney general’s office knew that. I was taking care of indigent patients. He put my patients at risk. I am still angry about that. And then I was basically sitting by myself eating a salad, still in scrubs. I was starving and really dehydrated because I had been on call the weekend and been up 48 hours before. There was a knock on the door. It was four agents from the attorney general’s office.

The whole way [to jail] I was asking God to help my family get through this. I have nieces and nephews, and my hospitalized patients, who found out about this on the 10 o’clock news, which was heinous. Had I known [about the arrest], I could have spoken to my patients. Instead I just don’t show up and they see me on the news. There were cancer surgeries that had to be rescheduled. These patients’ treatments were delayed because of what happened. I am still furious about it. It just really makes me mad.

How did the ordeal affect your mom, who is 84, and your family? And husband?For my family there’s been a lot of highs and lows. Good days, bad days. My mother is a really remarkable person. My mother is an extremely religious person who has a lot of faith. She told me to put myself in the hands of Jesus and everything will be OK, and to hope and to trust. I never fully realized the power of prayer before this.

So when did you start practicing medicine again?I started practicing again in February. I don’t have to tell you about the shortage of physicians in the state. There aren’t a lot physicians in our state with head and neck cancer [as a specialty].

How did you feel when the grand jury declined to indict you?I really fell to my knees. I was home with my husband. I was so grateful for their fairness and grateful to God. I couldn’t believe it had happened. I was pretty much in shock for a couple of days, going, “Is it really over?” For two years it’s the most effective form of torture—the uncertainty and the waiting and waiting and having everybody take a shot at you.

What did you think when the attorney general said he still believes you committed murder?I actually felt sorry for Mr. Foti. What he did was so unprecedented and is typically not done. I know he had his reasons for doing it, but I just felt sorry that he couldn’t accept or respect the grand jury’s decision. Most prosecutors, if they don’t agree, they accept the grand jury’s decision graciously. Basically he didn’t show any respect for the grand jury’s hard work. I’m not going to dwell on that. I’m really going to move forward with my life. I’m not going to focus on Mr. Foti. I don’t want to go backwards.

How has this affected your feelings about practicing medicine?I love the practice of medicine. Fortunately or unfortunately it really defines who I am. I’m not going to let this make me bitter. I will always do what’s in the best interest of my patients. As a physician who makes hard choices regarding treatments, I’ll always continue to do what’s in my heart the right thing to do. I’m not going to let this taint what I do. I know the type of life I’ve lived.

Do you feel this will always be hanging over your head?Professionally, the patients I’ve taken care of in the past still call me every day—I had one this morning—who say they still want me to be [their] doctor. People say we know what you’ve been through and we’re so sorry. They know I’m sincere, they know my reputation as a caregiver. I don’t think this will be as big an issue as you think. People who know me, know me. In another sense, will this ever be over for me? No. Even though I’ve had some legal victories, nobody’s won here. There will always be the sadness of what happened at Memorial Hospital, of what happened to the city. I think everybody who lived though Katrina will carry the memories with them for the rest of their lives. How can that ever be over for anybody?

Wednesday, August 22, 2007

This is simply excerpted from the GUARDIAN newspaper in London, UK. Truly frightening stuff. I will post at the end of the item some information permitting you to support the academics in question.

Guantánamo in Germany

The Guardian, 21.08.2007

In the name of the war on terror, our colleagues are being persecuted - for the crime of sociology. By Richard Sennett and Saskia Sassen

'Terrorism" has two faces. There are real threats and real terrorists, and then again there is a realm of nameless fears, vague forebodings and irrational responses. The German federal police seem to have succumbed to the latter: on July 31 they raided the flats and workplaces of Dr Andrej Holm and Dr Matthias B, as well as of two other people, all of them engaged in that most suspicious pursuit - committing sociology.

Dr Holm was arrested and flown to the German federal court in Karlsruhe; he has since been put in (pre-trial) solitary confinement in a Berlin jail. Of course the police may have solid, rational knowledge they are withholding, but their public statements belong to the realm of farce. Dr B is alleged to have used, in his academic publications, "phrases and key words" also used by a militant group, among them "inequality" and "gentrification". The police found it suspicious that meetings occurred with German activists in which the sociologists did not bring their mobile phones; the police deemed this a sign of "conspiratorial behaviour".

Thirty years ago Germany had a terrible time with indisputably violent militant groups, and that leaden memory hangs over the police. And it may well be that "gentrification" is a truly terrifying word. But this police action in a liberal democracy seems to fall more into Guantánamo mode than genuine counter-espionage.

Consider the hapless Dr B a little further. He's not actually accused of writing anything inflammatory, but seen rather to be intellectually capable of "authoring the sophisticated texts" a militant group might require; further, our scholar, "as employee in a research institute has access to libraries which he can use inconspicuously in order to do the research necessary to the drafting of texts" of militant groups, though he hasn't writtten any. The one solid fact the cops have on Dr Holm is that he was at the scene of the "resistance mounted by the extreme leftwing scene against the World Economic Summit of 2007 in Heiligendamm", perhaps mistakenly believing he is studying this scene rather than stage-managing it.

These are not reasons for Brits, any more than Americans, to cluck in righteous disapproval; in the long, sad history of the IRA, reality and fantasy entwined in an ever tighter cord. But, apart from hoping that our colleague Dr Holm will be freed if only he promises to carry his mobile phone at all times, we are struck by the grey zones of fragile civil liberties and confused state power that this case reveals.

The liberal state is changing. In the 60s, Germany had the most enlightened rules for refugees and asylum seekers in Europe; the US passed the most sensible laws on immigration in its history; France granted automatic citizenship to all those born on its territory, including all Muslims. Today all these countries have, in the name of the war on terror, revised their rules - the state of emergency prevails. The laws meant for real threats are invoked to counter shapeless fear; in place of real police work, the authorities want to put a name - any name - to what they should dread. States of emergency are dangerous to the legitimacy of states. In cases conducted like this one, a government stands to lose its authority and so its ability to root out actual terrorists.

If our colleagues are indeed dangerous sociologists, they should be prosecuted rationally. But, as in Guantánamo, persecution seems to have taken the place of prosecution.

Richard Sennett is a sociologist at the London School of Economics; Saskia Sassen is a sociologist at Columbia University

Monday, August 20, 2007

Hey, what a tendentious headline this is... I don't mean to write about medical professionalism African style, but about the disgraceful conduct of the (current, and would you believe it, still in office) South African Minister for Health Prevention, Dr Manto Tshabalala-Msimang. Manto has succeeded for several years to aid and abet the line of her boss, Thabo Mbeki, on HIV/AIDS. Hundreds of thousands of South African people with HIV/AIDS died preventable deaths because those two shady characters colluded in slowing down the roll-out of effective life-preserving AIDS treatments for as long as was/is feasible. She instead continued to promote various vegetables as a serious alternative to proper AIDS treatments.

Of course, as is usually the case when it comes to such people, there's one rule for the people and another for the rulers. All the politically correct rhetoric of the ANC is not going to change that. It has since transpired that Manto,a card carrying member of the League of Continuing Alcoholics (LCA), jumped the queue in order to access a fresh liver. It would have been very difficult for her to continue drinking otherwise. Other people of her age who happen to continue to enjoy large quantities of alcohol (as she does) tend not to get access to life-preserving new organs. These scarce resources are usually preserved for people younger than Manto, and people who, unlike Manto, stopped drinking. Well, despite much by way of denials (attending doctors were seemingly pressured into claiming that her alcohol induced liver disease wasn't alcohol induced...), it's clear now that the country's health prevention minister is not only incompetent but also otherwise unfit to run the Department of Health. She doesn't seem to mind bending the rules that have been put in place to allocate scarce transplant organs justly in the country.

Since these facts came to light it was also discovered by an investigation published last weekend by the country's SUNDAY TIMES that Manto was fired a couple of years ago from her day job as a superintendent at a hospital in Botswana because she stole plenty of hospital property and even a watch from a patient who was undergoing surgery under full anaesthesia.

Here's a revealing excerpt from yesterday's SUNDAY TIMES:

This week some of the key witnesses who testified during her trial and who had worked with Tshabalala-Msimang at the time, told the Sunday Times that jewellery, hats, handbags and even shoes had disappeared from the hospital over several months.

They had not suspected Tshabalala-Msimang and had were shocked when she was arrested for the thefts.

“It was unbelievable that a superintendent of the hospital would do something like that,” said a retired nurse who worked at the hospital at the time. Tshabalala-Msimang was arrested after an oval-shaped watch belonging to a female patient disappeared while she was under anaesthetic. The theft was reported to the police. Tshabalala-Msimang was arrested when she arrived at work three weeks later, wearing the watch. Staff contacted the investigating officer and Tshabalala-Msimang was arrested in front of her employees. A warrant was obtained to search Tshabalala-Msimang’s home and police found, among other things, linen, blankets and heaters that belonged to the hospital.'

So, an incompetent, drinking crook that is how one could best describe South Africa's Minister for Health Prevention, Dr Manto Tshabalala-Msimang. No wonder the ANC leadership has promoted her straight into the health department. There are only few senior people in the ANC that haven't managed to get their hands in one till or another, so Manto probably had the perfect character profile for the job.

Mind you, there's still people left in South African medical schools seriously trying to teach ethics.

Tuesday, August 14, 2007

I just came across this info in a book that I am reading (Irene Hames, Peer Review and Manuscript Management in Scientific Journals, Blackwell, Oxford 2007): In 2002 some 3000 or so scientists funded by US taxpayers through the US National Institutes of Health were interviewed (anonymously) about professional misconduct related to their scientific research. They were asked to report misbehavior during the preceding 3 years, and the only scientists interviewed were those in early or mid-career. One out of every three such scientists admitted some form of misbehavior 'in the top-10 most serious categories during the previous 3 years.' (pg 175) 6% of those interviewed failed to represent data that contradicted their hypothesis, 5% had published the same data already elsewhere (redundant publication), 10% assigned authorship inappropriately (eg to people who w ere not involved in the research), etc.

Based on my experience these problems start well at undergraduate level, because universities don't bother hard enough to try to stamp out academic misconduct. No dramatic surprise then that there's a substantial minority of scientists who think that such conduct is, if not acceptable, but certainly no big deal. What the data I have just reported also reveal is that folks usually get away with such conduct and that only a small minority get caught ... bad news all round.

Saturday, August 11, 2007

Margaret Somerville, the Vatican's permanent representative at McGill University in Montreal has published a piece titled 'If same-sex marriage, why not polygamy?' in today's Globe and Mail. She issues another dark warning that gay marriage (which as a Vatican emissary she doesn't like much) would lead to even worse stuff like polygamy. It's a truckload of bollocks, really, but it's fun to read, mostly because it is so badly argued that one wonders whether the newspaper just wants to get angry responses tearing her argument apart.

Anyway, keeping with the spirit of trying to entertain during the weekend, I wrote this tongue-in-cheek letter to the editor of that paper.

'Sir,

I read with great interest Professor Margaret Somerville's incisiveanalysis on the vexing issue of gay marriage and polygamy (Sat Globe'If same-sex marriage, why not polygamy?'). I am always amazed howProfessor Somerville manages to write brilliant treatises on ethicalissues, given her near-lack of professional training in the area. Notonly that, in a world of overpopulation, the destruction of theenvironment, genocides and mass murder, she routinely addressesethical issues that really matter, such as polygamy.

Her analysis cannot be faulted. She realises that there is no need toprovide reasons in support of her basic premise. We all know, deepdeep in our souls, that the only and the true reason for why peopleshould get married is in order to breed. It's all nice and well thatthose homosexuals go on about loving each other, but surely it isself-evident that love is neither necessary nor sufficient formarriage. It takes true intellectual leadership, such as thatdisplayed by Professor Somerville, to drive such obvious points hometo our by and large ignorant populace.

As a great admirer of Professor Somerville's leadership in a fieldthat in many, tragic ways ignores her, allow me to draw a few furtherconclusions that seem to follow from her path-braking analysis. Itseems to me as if we need urgent legislation designed to dissolve allmarriages that have not been reproductively successful within acertain period of time. It would make much more sense to enterreproductive losers back into the pool of potential breeding partnersand let them marry again. So, may I suggest that, as a first step, weagree on a time-limit on marriages. If there's no off-spring within,say, a year, we issue a first warning, second and third warnings couldfollow within a few months. If no pregnancy ensues there must becompulsory divorces. There is no other way. We should not get swayedby some overly romantic nonsense such as the couple's professed lovefor each other. No breeding, no marriage. End of story. Furthermore,we urgently need to introduce pre-wedding fertility tests. After all,if they can't breed, they can't breed, they can't marry. Of course, wemust be very careful with folks trying to cheat the system by means ofartificial reproduction, surrogacy or (horror of horrors) adoption.Just because there are a few million orphans on this planet doesn'tmean we should allow non-breeders to get away with such betrayal ofthe primary function of marriage.

Prof Schuklenk is author of 'How He Did it in Seven Days', 'WhyNon-Breeders are Losers' and other essays, Flat Earth Press: Roma.'

Friday, August 10, 2007

Usually in the context of the abortion controversy, religiously motivated health care professionals claim the moral (and often legal) right to conscientious objection to the provision of certain health care services. The basic idea is that if, say, Christian doctors and nurses object for religious (conscience) reasons to abortion they should not be forced to provide such services. On the face of it this seems uncontroversial. I think both accepting such conscience based refusals to provide health care services as well as assuming that such decisions are uncontroversial is mistaken. Let me explain why.

First things first: health care professionals such as doctors and nurses are first and foremost called upon by us as members of society as professionals and not as members of the Communist Party, the Klu Klux Clan, the local chess club, or a particular church. They provide a public service. In return for this we as society grant them a monopoly on the provision of such services (eg doctors have a monopoly on the provision of many health delivery services, including the prescription of drugs). We as society also invest substantial amounts of public funds into their training.

In many countries abortion is legal to some extent or other. In other words, societies have decided that it is ethically acceptable for women to make such choices (usually within certain well-defined limits). In societies providing public health care, women are entitled to receive abortion services through health care professionals that are publicly funded. These professionals are seen by pregnant women for the purpose of having an abortion. They are sought out as professionals and not at all as private individuals with their own private views on the morality or otherwise of abortion. I think it is preposterous to suggest that such professionals could kind of opt-out of the provision of some services because they feel strongly about such services.

Religious provisions are more or less arbitrary. Some make sense, others don't, and among religions there is little consensus on what is and isn't ethical. To permit the delivery of health care to be controlled by what amounts essentially to a lottery is unacceptable. Patients treated by a public sector doctor belonging to Jehova's Witnesses wouldn't get blood transfusions, those falling into the hands of an adherent to the Scientology Church won't receive antidepressants, the list is endless. It's easily imagineable that a racist doctor belonging to a suitably racist church could refuse to provide life-preserving services to patients from ethnicities other than her own. The conscientious objection to abortion crowd might not like to hear this, but there is no in-principle difference between their objection and that of the medic belonging to the Aryan Nation Church of Jesus Christ Christian. They will, of course, claim that they have 'better' reasons and that the competing church (ie the smallish racist outfit) is either not a 'real' church or that the racists are 'wrong' etc. The thing is, strictly speaking, none of this can be shown to be true, because, as it happens all monotheistic religions depend on untestable claims about the existence of 'God'.

A reliable delivery of health services (and this include equitable access) depends on guaranteeing timely access based on health need. Conscientious objections are a serious threat to precisely that. If you are a pregnant woman living in a rural area with a limited number of predominantly conservative Christian or Muslim doctors you might well not be able to execute your legal right to have an abortion at a certain point in time, if respect for conscientious objections was considered to be of greater importance than your access to services. This argument is very powerful indeed, when you consider the dearth of health care professionals serving the public sector in developing countries.

So, the sooner we get rid of the right to conscientious objection, the better for us, the public. And to be clear, if health care professionals feel strongly enough about this matter, they should be invited to leave the profession and do something else with their lives. We cannot reasonably permit a pick-and-choose type interpretation of professionalism to become the norm.

As someone who has taught for many years in medical schools, I can testify to quite a number of people who have chosen dentistry over medicine, for instance, because they did not wish to ever have to face the moral conflicts that come into play in the abortion controversy or end-of-life decision-making. In all honesty, these professionals deserve our respect for what I think is a grown-up understanding of what it means to be a professional.

Thursday, August 09, 2007

Interested observers will know that South Africa is currently run by the ANC's President Thabo Mbeki (who informed interviewers repeatedly that he doesn't know a single person who died on AIDS in his country, and who expressed doubts that HIV is the cause of AIDS).

His Minister for Health Prevention is Manto Tshabalala-Msimang (who offered at one point in her illustrious career beetroot, the African potato and garlic as a means to prevent AIDS). They both continue to conspire against millions of HIV infected South Africans with a wide array of truly idiotic statements and every effort to slow down the roll-out of antiretroviral treatments as good as is feasible (ideally without getting caught).

Eventually they were forced by mostly court decisions to stop the HIV related genocide that they were quietly organising and presiding over. Still, things happen even to truly nasty people like the Pres and his sidekick Manto. Manto, who would fit nicely into Scotland, given her interest in booze, had to be taken out of action to get a new liver (as her old liver truly couldn't handle the amount of alcohol she's guzzling). While she quickly jumped the queue to get a new liver (makes sense, who else would assist so kindly in executing Thabo Mbeki's genocidal activities), her Deputy Minister Nozizwe Madlala-Routledge took over. She is an old hack of the South African communist party and so a member of a party belonging to the triparty alliance making up the government of the country. Being not an ANC cadre she didn't have to insists that the earth is flat, pigs can fly and AIDS is a conspiracy against Black people organised by the CIA and the international pharmaceutical industry bent on selling poisonous AIDS drugs to South African Blacks. There was no need for her to peddle 'African solutions' such as beetroot, African potatos etc etc (as Manto suggested in between a couple of drinks during one of her conference appearances).

Well, Madlala-Routledge worked tirelessly toward getting AIDS ttreatment programs off the ground while Tshabalala-Msimang jumped the liver transplantation queue. It was only a matter of time until she would be cancelled by Thabo and his sidekick, and today she was. The pretext was that she went to (would you believe) an AIDS conference in Spain even though Thabo the Pres explicitly refused her travel. Stupidly Madlala-Routledge seems to have dragged her son and various hangers-on along so this had all the make-up of a junket trip. A good pretext to fire her. Here's a statement on her dismissal from the South African HIV/AIDS Clinicians' Society that I received a few minutes ago. I would normally encourage you to write to the SA High Commission or Embassy in your country and ask that you criticise her dismissal, but what's the point, thhe High Commissioners and ambassadors would report back to Thabo the Pres who is the bloke who fired her in the first place... welcome to the ANC owned rainbow nation in action.

We are an organisation of over 12 000 health professionals working in HIV care in the Southern Africa region. http://www.sahivsoc.org/ We support the Rural Doctors Association of Southern Africa (RuDaSA) statement issued on 9th August 2007, National Women’s Day. We believe that Deputy Minister Nozizwe Madlala-Routledge has played a fundamental role in bringing civil society and professionals together to support the government’s National Strategic Plan (NSP) for HIV/AIDS, on an unprecedented level. She demonstrated compassion and commitment to South Africa’s population, with a respect for science and public health that made us realise what we should demand from all public servants. The manner of her dismissal (on Women’s Day), when so much positive work has been done in the area of HIV, to provide political and public leadership for the first time, is deeply distressing.Furthermore, it comes when we are seeing alarming signs of a return to the rhetoric and confrontation of the past over HIV. The Society has asked for urgent clarification, as have others, as to why the mother-to-child HIV prevention programme (PMTCT) has not been expanded beyond 30% coverage after 5 years, and why more effective regimens have not been implemented. Yet again, court action is being threatened as the last resort to force action on this issue. Fewer than 20% of adults requiring antiretrovirals are receiving them, after more than 3 years of publicly available ART. Minister Manto Tshabalala-Msimang, since her return from sick leave, has not addressed these worrying problems. Instead she has focused on the (unsubstantiated) high price of future antiretrovirals, claims of good geographical ‘coverage’ for PMTCT and ART access, and continued references to South Africa having the ‘largest and most comprehensive response’, without critical appraisal of those who do not access HIV care. For HIV infected people, their families, and their caregivers, this looks like more of the same – the Minister demonstrating antagonism to the one thing that can save their lives – antiretroviral therapy. It is deeply ironic that price is cited by the Minister as an issue in access to antiretrovirals, when it has taken the bravery of activist groups and professionals, rather than her own department, to fight for current affordable HIV care. Finally, we remain deeply concerned that the targets set for the NSP for 2007 look increasingly unrealisable. Since their publication, no plan has been forthcoming on how to attain the ambitious targets set in the Plan.Our country desperately needs trusted and brave leadership in the area of HIV. The deputy minister gave us hope that this was possible. We wish her well, and thank her for giving us hope and leadership. We recommit ourselves to ensuring that government, the elected steward of our health system, is held accountable for decisions regarding health care for HIV-infected people.On behalf of the Executive, SAHCS.'

I do apologise for the lengthy and seriously tendentious headline of this blog entry, because the story underneath it is actually important. So, here's the background: a couple of members of the California Assembly introduced a bill permitting the legalization of assisted dying for terminally ill competent people who have less than six months to live. Of course, predictably, the Roman Catholic Church campaigned against the measure. I have a hunch that you just might be familiar with its arguments (dignity of human life, infinite value of life those living this life do not actually consider worth living - stuff like that). In any case, the bill was defeated partly or primarily because disability rights (lobby) groups in California sided with God's lobby group. Their argument is an interesting one based on a factual claim.

What they're saying, basically, is that disabled people's lives are already curtailed by secretive and not so secretive cost cutting byHMOs. They worry that once physician assisted dying becomes legal, HMOs might, in their usual secretive and not so secretive ways, withhold care sufficiently from patients in order to ensure that these patients choose (arguably not so voluntarily then) physician assisted dying as a way out of their misery.

Well, I am - in principle - very much in favor of assisted dying and indeed some forms of euthanasia. But, equally, I do think this argument merits serious consideration. We know that not only for-profit health care operators tend to display corner-cutting behaviors but also non-profit public health care facilities. The latter might well argue that overall utility is better served when under circumstances such as those described at the beginning of this blog entry, the lives of those affected are cut short by a few weeks or months.

There are various interesting aspects about this. One is the diversity of responses one gets from disabled folks on this issue. In California disabled people were found on both sides of the divide, suggesting that for some, despite worries about abuse, access to a dignified death is more important than the possibility of HMOs aiming to speed up the meeting with God (or the encounter with nothing, or ... who knows). My hunch is that this is a perfectly reasonable expression of different values, but also possibly of different life experiences. Those disabled people who made already bad experiences with their HMO are anxious as they have seen what these operators are capable of doing, while those who did OK are more concerned about controlling their process of dying.

The other aspect that I find worth thinking about is the 'what if the anxious folks are right' type argument. It seems to me that they're saying that things, by way care for the disabled, are already pretty bad. If that is a true representation of the facts of the matter (and I do not know whether or not that is the case), it seems to me that assisted dying might be preferable to languishing at the hands of a lousy HMO. Dying people might be better off if assisted dying was available to them under such circumstances. This is not to say that one should not undertake steps to prevent such suboptimal care from happening! So, in response to this worry, the answer seems to be that we should both improve the care provided by HMOs to disabled dying people (possibly to disabled people - period!), and that the implementation of this ought to be more tightly monitored. It does not seem to be a particularly good reason to prevent those dying disabled people who wish to access assisted dying from doing so. The objective should be to ensure that those who don't want assisted dying are not made to ask for it by means of unacceptable levels of care.

The Joint Working Group (JWG) is a national network of LGBTI-focused organisations in South Africa. The JWG represents the organised LGBTI (lesbian, gay, bisexual, transgender and intersex) sector, and speaks and acts in the interest of our respective and diverse constituencies.

WOMEN ARE STILL MARCHING FOR FREEDOM

The Joint Working Group, and its partners in the alliance to end hate crimes, will be marching in Soweto this Women’s day, in response to the recent, brutal killings of two lesbian women in this community.

Thirteen years after democracy women is South Africa are still plagued by violence, are not safe in their homes and communities, and are held hostage by the collective oppressions of sexism and homophobia.

As LGBTI people, we take to the streets on Women’s Day to demand our freedom: Freedom to be safe; freedom to express our sexualities; and freedom to claim and enjoy our constitutional rights.

We call on our women leaders to break the silence on sexism and homophobia and to express their outrage at all forms of gender-based violence; and at the murders of all women, including lesbian women.

We call on our police services to demonstrate their commitment to ensuring the safety of women, and to take concrete and visible action towards the elimination of all form of gender-based violence.

We understand that four men have been arrested in connection with the killings of Sizakele Sigasa and Salome Massoa, but have yet to be charged. We urge for a thorough investigation, followed by an appropriate charge and a successful prosecution of the perpetrators.

We march in honour of Sizakele and Salome, and of all the other women who have been senselessly killed by prejudice. We march to demonstrate that we will continue the struggle for freedom from gender oppression, for as along as it takes.

Wednesday, August 08, 2007

I have argued in a book that was published nearly... 10 years ago (I am ageing, I guess, kinda like everyone else) that we should provide terminally ill patients who have only a limited time left access to last-chance type drugs (more precisely experimental agents). Just go to amazon and search for my last name, you'll see the treatise popping up still. Anyway, a correspondent sent me this link today. Interesting story. Here is a brief summary of what it's all about:

'The Abigail Alliance for Better Access to Developmental Drugs and the Washington Legal Foundation sued the FDA in 2003, seeking access for terminally ill patients to drugs that have undergone preliminary safety testing in as few as 20 people but have yet to be approved.FDA spokeswoman Susan Cruzan said the agency was pleased with the decision, which she said considered the public’s safety and the need for access to experimental drugs. Abigail Alliance founder Frank Burroughs pledged an appeal to the Supreme Court. Burroughs’ daughter, Abigail, was denied access to experimental cancer drugs and died in 2001. The drug she was seeking was approved years later.'

The FDA is the US Food and Drug Administration. It is responsible - among other things - for drug safety, and therefore the market approval of drugs. Quite rightly so, it takes its time to ask for scientific proof that new medicines are safe and efficient before it approves them for our use. The interesting ethical question, however, is whether it's acceptable to prevent dying people from making an informed choice about whether or not they're taking their chances with experimental agents. It is not necessarily irrational for a dying person to decide to take even huge risks in the face of death. What one would require really to make things work is a competent patient (terminal illness doesn't render you incompetent, you know!) who understands how little is known about an experimental agent, and who decides autonomously to give it a shot anyway. It is not always irrational to do so. This is so, because someone could weigh the pro's and con's and decide that it's worth the obvious risks involved in taking experimental agents. People might want to take their chances, seeing that death is a certainty if they don't do anything at all. I don't mean to bore you here with what I said in the book and in a series of academic articles at the time. You should easily be able to trace em if you're interested.

What I find very significant is that of about 9,500 folks who participated in the on-line poll conducted on the website I linked to earlier, 94% thought that we should enact legislation permitting dying patients to make such choices. This is much in line with other polls providing consistently overwhelming majorities in favor of the legalization of voluntary euthanasia. The bottom line we continue to send to our democratic representatives is that we want to maximise control of our lives when we are dying. Equally consistently legislators tend to ignore our wishes. That's liberal democracy Western style for you ...

I have argued in a book that was published nearly... 10 years ago (I am ageing, I guess, kinda like everyone else) that we should provide terminally ill patients who have only a limited time left access to last-chance type drugs (more precisely experimental agents). Just go to amazon and search for my last name, you'll see the treatise popping up still. Anyway, a correspondent sent me this link today. Interesting story. Here is a brief summary of what it's all about:

'The Abigail Alliance for Better Access to Developmental Drugs and the Washington Legal Foundation sued the FDA in 2003, seeking access for terminally ill patients to drugs that have undergone preliminary safety testing in as few as 20 people but have yet to be approved.FDA spokeswoman Susan Cruzan said the agency was pleased with the decision, which she said considered the public’s safety and the need for access to experimental drugs. Abigail Alliance founder Frank Burroughs pledged an appeal to the Supreme Court. Burroughs’ daughter, Abigail, was denied access to experimental cancer drugs and died in 2001. The drug she was seeking was approved years later.'

The FDA is the US Food and Drug Administration. It is responsible - among other things - for drug safety, and therefore the market approval of drugs. Quite rightly so, it takes its time to ask for scientific proof that new medicines are safe and efficient before it approves them for our use. The interesting ethical question, however, is whether it's acceptable to prevent dying people from making an informed choice about whether or not they're taking their chances with experimental agents. It is not necessarily irrational for a dying person to decide to take even huge risks in the face of death. What one would require really to make things work is a competent patient (terminal illness doesn't render you incompetent, you know!) who understands how little is known about an experimental agent, and who decides autonomously to give it a shot anyway. It is not always irrational to do so. This is so, because someone could weigh the pro's and con's and decide that it's worth the obvious risks involved in taking experimental agents. People might want to take their chances, seeing that death is a certainty if they don't do anything at all. I don't mean to bore you here with what I said in the book and in a series of academic articles at the time. You should easily be able to trace em if you're interested.

What I find very significant is that of about 9,500 folks who participated in the on-line poll conducted on the website I linked to earlier, 94% thought that we should enact legislation permitting dying patients to make such choices. This is much in line with other polls providing consistently overwhelming majorities in favor of the legalization of voluntary euthanasia. The bottom line we continue to send to our democratic representatives is that we want to maximise control of our lives when we are dying. Equally consistently legislators tend to ignore our wishes. That's liberal democracy Western style for you ...

Tuesday, August 07, 2007

You know, I have always been somewhat dismissive of the law as a good means to take forward political causes. I always thought one needed to win the substantive normative argument first, and then, somehow, miraculously the law would fall into line. Well, while I worked in South Africa for a couple of years, the Treatment Action Campaign there gave me much food for thought. They used legal cases to advance usually sensible policy matters. Of course, sometimes the law can be an ass and nothing can be achieved by means of suing one's way through the courts, but there are two cases reported today that suggest that sometimes at least the legal route just might be the more efficient way to achieve particular ethical or policy objectives.

The first case could best be described as: Whales: 1, US Navy: 0. Check it out here.The second case I reported about on this blog. I learned today that Novartis lost its case in the Indian High Court.

Mind you, none of this shows that critical analysis and argument are not called for, but equally it seems fair to say that in some circumstances a good team of lawyers can replace a lot of academic papers and books and campaign officers, if one is concerned about achieving desireable outcomes at all.

Monday, August 06, 2007

I am not a great fan of right-wing news outlets like the WELT newspaper in Germany, but at least they can reasonably reliably be trusted to inform us about murder committed by Iran's President Mr Ahmadinejad and his fellow Muslim compatriots. While the political left has been busily wringing its combined hands over the botched hanging of secular mass murder Sadddam Hussein, there is an eerie silence from that crowd when Islamic states engage in the slaughtering of the innocent. No wonder, one doesn't want to be seen sitting in the same boat as US President Bush and other religious Christian fundamentalists in their condemnation of anything not Christian. Well, frankly, I think this won't do.

In this lengthy blog entry journalist Stefan Wirner reports about the barbaric public hanging of 16 Iranian (innocent) citizens. In the same week 2 journalists critical of the regime were sentenced to death. Funny enough, there have been no demonstrations in front of Iranian embassies the world all over reported. Presumably 'progressive' people were too busy decrying the force-feeding of Islamic prisoners in Guantanamo Bay. To be clear, the very existence of Guantanamo Bay is unacceptable, and so is the force-feeding of prisoners in that facility. Surely, however, the execution of 16 Iranians whose only crime has reportedly been that they were homosexuals (or were assumed to be homosexuals) should have led to a substantially larger international outcry, yet there has been near-complete silence.

There is still time to do something about the two journalists, Abdolwahed Bohimar and Adnan Hassanpur. They were reportedly condemned to capital punishment because they were found guilty to be 'enemies of God'. This suggests that my blog entry just below, if I were unfortunate enough to be a citizen of Iran, could put me comfortably in the very same situation as Bohimar and Hassanpur. As always, one hasn't heard from the ever-growing number of Islamic human rights organisations, usually busying themselves with fighting for women's alleged 'right' to wear complete veils, as well as decrying cartoons of their respective God while displaying silence on cases such as those just described. A s soon as this sort of double-standard is pointed out (usually by someone conservative - which, incidentally I am not), invariably someone (liberal) will come to their defense and mumble something about besieged religious minority and stuff like that. My honest take on this is that a lot more people would take Islamic human rights activists seriously if they became active in such matters, too. After all, as Muslims their protests would likely have a bigger impact on a regime such as the Iranian than my biased bickering. So, may I suggest that civil rights are indivisible and everyone playing in this political arena should go out of his/her way to ensure that he/she is seen to treat them like that.

I wondered for awhile whether this is a real cheap shot, and not even an entirely original at that, and decided to go for today's blog entry anyway. While it is true that all monotheistic religions have in common one feature, namely intolerance (they believe their's is the only 'true' religion and every competitor's religion is bollocks), I think that not all of them also claim what the Christian religions have on offer re their God. Christianity makes the following claims about its God:

God is all-knowing (omniscient)God is all-powerful (omnipotent)Gods is good.

These three claims form to a large extent the basis for the proposition that we should worship God. Of course, there's that tiny issue of not knowing whether God actually exists at all, but this is not at the moment of concern to me. Let's assume God exists, what does the world as it exists tell us about these three claims?

What does, for instance, the Holocaust during the Nazi regime in Germany, the genocides in Rwanda and elsewhere tell us about God? Indeed, what do millions of HIV infected newborns in developing countries tell us about God? What does the fact that God doesn't interfere when George W Bush claims to execute its wishes tell us about God?

Well, for starters, we would need to agree that the Holocaust really happened, and that it was a pretty horrendous thing (ie if you belong to the Holocaust deniers, we would have little to argue about; equally, if you think the Holocaust was kinda cool, we would have little to argue about either - this is not because I agree with you, but my first premise really is that the Holocaust happened and that it was a very bad thing). Equally, the genocide in Rwanda was a terrible event, and even with a lot of fantasy I can't see how one could conclude that millions of HIV infected newborns are a good thing. It's also probably fair to say that neither the Jews nor the Tutsis nor the newborns really deserved their fate.

Which brings me back to our good, all-knowing and all-powerful God. If God exists at all, it seems to me that it is not very likely to be either good (how could a good, omniscient, omnipotent being not intervene when such injustice is being perpetuated?). Or, perhaps it isn't omnipotent and omniscient (how could it not foresee what was going to happen and put a stop to it?). So, my main point is that these events and very many like them either demonstrate that God does not exist at all (because the claims made about it are untrue), or that God, if it exists, might actually be evil. Evil, because it had the power and knowledge of upcoming events like the Holocaust, Rwanda's genocide, the kidnapping, rape and murder of innocent children by pedophiles, (the list of human made atrocities seems kind of endless), or natural disasters such as earthquakes, tsunamis and the like, yet it chose not to do anything about it.

Either of these two outcomes suggests that we should not worship this particular God, because God either doesn't exist or is not what we are made to believe (by religious leaders) that it is. A substantial religious cottaging industry has developed to explain this problem away (the theodizee problem, ie God and Justice). The most famous response to this challenge came from a German philosopher, Gottfried Wilhelm Leibniz. Leibniz suggested a couple of hundred years ago in his Essais de Theodicee sur la bonte de Dieu, la liberte de l'homme et l'origine du mal : suivi de La monadologie that because God has all those attributes I have just mentioned it follows that this is the best of all possible worlds. If anything, we're less then perfect and for that reason unable to see how wonderful it all really is. Voltaire responds in one of my favourite works of enlightenment philosophy, his Candide. It's one of those books that I think one should have read before one hits the sack for good. - So, I am not really aiming to reinvent the enlightenment wheel here, but I thought it's worthy of repetition as those confronted by it (namely monotheistic religions making these three claims) truthfully had nothing to say in response.

A lot, in fact follows from this critique. For one thing, we should be suspicious whenever representatives of these types of religions tell us that this and that technology (stem cell research), or that this and that behavior (extramarital sex, gay or otherwise) is bad, because their God doesn't like it. Frankly, their God, if it exists at all seems to be a loser of such gigantic proportion that we have no reason to give a hoot at all. In fact, knowing that their God doesn't like something that we would like to do should encourage us to go for it (subject to no non-consenting parties getting hurt or harmed in the process, of course).

Friday, August 03, 2007

There's something truly strange about this. East Germany, especially under the iron rule of the former Communist Party, went out of its way to welcome foreigners and celebrated international solidarity. And yet, we (well, we in the West) always kind of knew, that the average East German was substantially more conservative (a Spiessbuerger) than the average West German citizen. It didn't come as a great surprise then that after the fall of the wall and the purchase of East Germany with the West German mark (aka the 'unification') xenophobia and racist attacks would be much worse in the East than they were in the West.

Things have deteriorated ever since. During the recent soccer world cup leading politicians of the Labor Party (a party represented in the federal government) warned people belonging to visible ethnic minorities not to venture too far into the East because their safety could not be guaranteed. For German government politicians to acknowledge that law and order could not be guaranteed everywhere in the country was a colossal kind of some sort of defeat for the liberal democracy that Germany undoubtedly is these days.

Since then incredibly so, things have got worse. Reports suggest that police officers fail in their duties toward victims of racially motivated attacks and other forms of violence. For instance, recently a Vietnamese family was attacked by several adult males from the neighbouring flat, they gained entry by kicking the door in. Eventually the vandals left and the Vietnamese family called the police in. Officers duly showed up, interviewed the attackers and left. Wisely the Vietnamese family left their home and slept elsewhere. The Neonazis returned that very same night and vandalised the family home. Police was nowhere to be seen.

Thursday, August 02, 2007

Here's a true story from Canada. It looks like 'market-friendly' forces in the Canadian Medical Association (CMA)are campaigning to allow the part-privatization of health delivery services. To be fair, a lot of health delivery services in Canada are actually private. For instance, much like in the UK, for some bizarre reason dental care isn't part of 'free at the point of delivery' care that public health care systems usually take pride in. Pride one should take in such public systems because they permit equitable access based on health needs as opposed to individuals' capacity to pay.

Well, the current CMA leadership aims to permit doctors to take on private patients. The argument is that this could reduce public sector waiting lists. Surely, this is either disingenious or mischievous. Public sector waiting lists in this country are seriously out of sync with delivery needs. This suggests that Canada likely invests insufficient resources into the training of future health care professionals.

Whatever the cause of the suboptimal supply of health care professionals (certainly GPs) in Canada, one thing is clear, the proposed piecemeal privatization of the public service will not change that status quo. If you have X numbers of physicians working today in a given country's public health service (and X is a fixed number), permitting those professionals who make up X (the group) to work in private practice is not going to change the number of professionals making up X.

What it does, however, is to create a market for health services. Those who are able and/or happy to pay will be able to jump the queue that exists in the public sector. They indeed will see their waiting times slashed. Of course, privatization is fundamentally about (not to say against) equal access. Equal access is undermined because if X remains stable (ie the number of GPs per 100 population), a smaller number of clinicians would have to serve the larger number of folks who couldn't afford private services. A large numbers of people will predictably be worse off, a smaller number will equally predictably be better off.

Which shows that the CMA is a doctors' trade union. It's more concerned about increasing doctors' income then patient welfare.